A fall, especially one resulting in a nosebleed, can be an alarming experience for a parent. Minor falls are common occurrences for infants and toddlers as they explore their environment and develop coordination. The sight of blood can be stressful because the nose and face are highly vascular areas, meaning even a small injury can lead to significant bleeding. Understanding the immediate steps to manage the bleeding and knowing the warning signs of a more serious injury can help a parent respond effectively and calmly.
Immediate Steps to Stop the Bleeding
The first action is to remain calm and immediately comfort the child, as their distress will often mirror the caregiver’s reaction. Once the child is settled, position them sitting upright, leaning slightly forward at the waist. This posture prevents blood from trickling down the back of the throat, which can cause gagging, nausea, or vomiting.
Next, gently pinch the soft, lower part of the nose—just below the bony bridge—using your thumb and forefinger to apply direct pressure. This technique compresses the small blood vessels, allowing a clot to form. Maintain this pressure continuously for a full five to ten minutes without releasing it to check the bleeding. Releasing the pressure prematurely can dislodge the forming clot and restart the flow.
While maintaining pressure, applying a cold compress or a wrapped ice pack to the bridge of the nose or the back of the neck can help constrict the blood vessels. If the bleeding continues after the initial 10-minute period, repeat the process of applying pressure for another full 10 minutes. If the bleeding persists after two full attempts of continuous pressure, seek immediate medical attention.
Recognizing Symptoms of Head or Facial Trauma
A nosebleed following a fall requires vigilance for symptoms that indicate a more serious head or facial injury beyond a superficial nasal cut.
One concerning sign is any loss of consciousness, even if momentary, which warrants an immediate call for emergency services. Similarly, if the child has difficulty staying awake, exhibits excessive drowsiness, or is hard to rouse, this can be a sign of increased pressure within the skull.
Watch for persistent vomiting, especially more than two or three times, as this can be a symptom of a significant head injury. The drainage of a clear, watery fluid from the nose or ears, sometimes mixed with blood, may indicate a cerebrospinal fluid leak, suggesting a skull fracture. Unequal pupil sizes, or any signs of seizure activity are also indicators for immediate emergency care.
Concerning signs of facial trauma include obvious deformity of the nose, such as a crooked or bent appearance, or severe swelling that interferes with breathing through the nose. Severe lacerations on the face that continue to bleed heavily after 15 minutes of direct pressure should also be evaluated by a medical professional. Any change in the child’s typical behavior, such as extreme irritability, confusion, or difficulty walking or speaking, should prompt a medical evaluation.
Post-Incident Monitoring and Care
Once the bleeding has stopped and the child appears stable with no immediate emergency symptoms, careful observation over the next 24 to 48 hours is necessary. Parents should monitor for subtle changes in behavior that might indicate a delayed reaction to the fall, such as increased fussiness, unusual quietness, or a lack of interest in playing. It is acceptable for a child to sleep, but a parent should check on them periodically for any twitching limbs or changes in breathing, and they should be able to wake them easily.
To help prevent the nosebleed from recurring, advise the child to avoid strenuous activity for a few hours following the incident. It is important to discourage nose picking and nose blowing for the next few days, as these actions can dislodge the delicate clot that has formed and restart the bleeding. If the child experiences non-emergency but concerning symptoms, such as persistent paleness, a mild but lingering headache, or if the nosebleed recurs easily, contact a pediatrician for guidance.